Which lifestyle or dietary interventions, supplements, or medical treatments reduce menopausal symptoms such as hot flushes and mood swings in women going through menopause?

Hormone therapy with oestrogen comes first: it is the most effective treatment available for hot flushes and night sweats, and multiple guidelines confirm this consistently. It is most suitable for women who are within ten years of their last menstrual period and have no contraindications, such as oestrogen-dependent tumours or certain cardiovascular conditions. Women who cannot or do not wish to use hormone therapy now have a broad range of well-supported alternatives to choose from.

Three non-hormonal medications have received a recommendation for hot flushes on the basis of large clinical research (the highest level of evidence). SSRIs and SNRIs such as paroxetine and venlafaxine, drugs used in psychiatry as antidepressants, demonstrably reduce hot flushes but can cause side effects such as nausea, dry mouth, and reduced libido. Gabapentin, originally a drug for epilepsy and nerve pain, is also effective, but causes dizziness and drowsiness in some people. Fezolinetant is a newer class: it acts specifically on the brain mechanism behind hot flushes and also shows promise for sleep and mood complaints. Long-term data on this last drug are still being collected. Oxybutynin, better known as a treatment for bladder cramps, has also received a recommendation, but with somewhat less strong evidence; dry mouth is a common side effect.

Cognitive behavioural therapy (CBT) and clinical hypnosis are the two non-pharmacological treatments with the strongest scientific evidence for hot flushes, anxiety complaints, and sleep problems. CBT is a structured form of talk therapy that addresses thoughts and behaviour related to the complaints. Clinical hypnosis requires a specialist therapist, but has also proved effective in well-designed research. Both are fully valid options for women who prefer not to use medication.

For mood and anxiety complaints specifically, a meta-analysis of 32 randomised studies shows that dietary interventions, including omega-3 fatty acids and vitamin D, have a modest positive effect. The effects are statistically significant but small to moderate, and the large variation between studies makes it impossible to identify one specific supplement as a winner on the basis of this research. Weight loss has a recommendation for hot flushes on the basis of limited to consistent evidence, and also has broader cardiovascular benefits. Exercise and strength training improve physical and psychological wellbeing during the transition, but have not been convincingly enough proven for hot flushes themselves.

Herbal and plant-based supplements such as soy extracts, the soy metabolite equol, and cannabinoids are explicitly not recommended for hot flushes by the 2023 NAMS guideline: good to reasonable research shows insufficient effectiveness. The same applies to yoga, mindfulness, acupuncture, and paced breathing as treatments specifically for hot flushes; for the latter, the strongest type of evidence that it does not work actually exists. These techniques may improve general wellbeing, but are not a proven solution for hot flushes. A plant-based diet rich in phytoestrogens (plant compounds with a weak oestrogen-like effect) may potentially contribute, but the evidence for this is limited and inconsistent. Clonidine, licensed for hot flushes in some countries, is no longer recommended by the NAMS guideline due to side effects and insufficient evidence, although this differs by country.